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Current Research and Scholarly Interests

Dr. Thompsons interests include psychosocial treatments for individuals with bipolar disorder and /or other serious mental illnesses; cognitive/behavioral therapy for late-life depression; intervention research with culturally diverse individuals with depression; and psychophysiological research on stress & coping.

Abstract

The purpose of this study was to compare the relative effectiveness of three recruitment modalities for enrolling Chinese-American and white family caregivers into research studies to evaluate intervention strategies.A total of 116 Chinese Americans and 134 whites were screened for eligibility to participate in one of two clinical intervention trials. Participants were recruited using: 1) media sources; 2) nonprofessional referral sources; or 3) professional referrals. Each participant was asked an open-ended question about how they became aware of the programs offered.A smaller proportion of Chinese Americans (39%) than whites (50%) who responded to recruiting strategies actually enrolled as subjects. There was a significant interaction between ethnicity and recruitment strategy. Chinese-American caregivers who were recruited by nonprofessional sources were less likely to enroll in the intervention studies than those who were recruited through media sources or professional referrals. Whites, on the other hand, were more likely to be recruited through nonprofessional sources than the other two.A consumer-oriented approach, which included direct face-to-face contact with key community leaders, generated the highest number of Chinese-American participants. Culture-specific factors such as trust-building with social service agencies, demonstrating genuine commitment to the well-being of the target community, and linguistic and ethnic matching between research staff and potential participants appear helpful to successful research recruitment in this rapidly increasing segment of dementia caregivers.

Abstract

This study performed moderator analyses to determine if self-efficacy predicted differential outcome in a randomized trial comparing a cognitive behavior psychoeducational intervention and an enhanced support group (ESG). The four key outcomes were depression, anxiety, social support, and coping. Low baseline self-efficacy scores were hypothesized to be more predictive of positive response in the psychoeducational intervention than in the support group. Change from pre- to posttreatment (baseline to three months) for 213 female caregivers of older adult relatives with dementia (122 Anglos and 91 Latinos) are presented. Caregivers were randomly assigned to either the coping with caregiving class (CWC), a skill-building, small group intervention designed to reduce caregiving stress, or to an enhanced support group (ESG), which used guided discussion and empathic listening to develop within-group reciprocal support. The findings showed that low baseline self-efficacy scores better predicted positive response to treatment in the CWC intervention than in the ESG intervention. This study supports the use of self-efficacy as a screening tool for appropriate caregiver intervention assignment.

Abstract

This study examined differences in psychologic and physiological responses to caregiving stress in Hispanic and non-Hispanic white women dementia caregivers and noncaregivers. Dependent variables were perceived stress, depression, and salivary cortisol.Eighty-three women caregivers (20 Hispanic and 24 non-Hispanic white) and noncaregivers (19 Hispanic and 20 non-Hispanic white) completed the Perceived Stress Scale (PSS), Center for Epidemiological Studies-Depression Scale (CES-D), and collected three saliva samples daily for 3 consecutive days. A subsample of 17 Hispanic and 28 non-Hispanic white participants matched on age and education was used for the main analyses.Caregivers had higher levels of 8 am, 5 pm, and 9 pm log cortisol as well as higher perceived stress than noncaregivers. Non-Hispanic whites had higher depression scores than noncaregivers, but there was no significant difference for Hispanics. Hispanics, regardless of caregiving status had flatter daytime cortisol slopes than the non-Hispanic whites. Multivariate regression analyses showed that both ethnicity and depressive symptoms independently predicted daytime cortisol slope.Results support the relationship between chronic stress and hypothalamic-pituitary-adrenal axis dysregulation among women dementia caregivers and highlight the need to examine further the role of ethnicity and depressive symptoms in their physiological responses.

Abstract

The purpose of this study was to compare cognitive-behavioral group therapy (CBGT), clinical case management (CCM), and their combination (CBGT + CCM) to treat depression in low-income older adults (60+). Sixty-seven participants with major depressive disorder or dysthymia were randomly assigned and entered into 1 of the 3 treatment conditions for 6 months. They were followed for 18 months after treatment initiation on depression and functional outcomes. CCM and CBGT + CCM led to greater improvements in depressive symptoms than CBGT, but CBGT led to greater improvements in physical functioning. All 3 conditions resulted in similar reduction of needs. Findings suggest that disadvantaged older adults with depression benefit from increased access to social services either alone or combined with psychotherapy.

Abstract

While there has been considerable interest in studying ethnically diverse family caregivers, few studies have investigated the influence of dementia caregiving on Latino families. The current study includes participants from two sites of the REACH (Resources for Enhancing Alzheimer's Caregiver Health) project to compare well-being, appraisal, and religiosity by ethnicity, with specific attention to levels of acculturation. Latina (n = 191) and Caucasian female (n = 229) dementia family caregivers from two regions of the United States (Miami, Florida and Northern California) were compared at baseline on demographics, care recipient characteristics, mental and physical health, and psychosocial resources, including appraisal style and religiosity. Latina caregivers reported lower appraisals of stress, greater perceived benefits of caregiving, and greater use of religious coping than Caucasian caregivers. The relationship of these variables to level of acculturation for the Latina caregivers was also explored. Implications of these results for psychosocial interventions with Latino and Caucasian family caregivers are discussed.

Abstract

To compare rates of institutionalization of dementia patients cared for by Latina and Caucasian female caregivers and to explore which caregiver and care-recipient characteristics predicted institutionalization.Longitudinal.San Francisco Bay area, California.Two hundred sixty-four female caregivers of dementia patients (154 Caucasian women, 110 Latinas) who participated in an intervention project designed to reduce caregiver stress and may represent a sample that is more stressed and motivated than a general sample of caregivers.Number of days between baseline interview and institutionalization was recorded over an 18-month period. Kaplan-Meier survival analysis with the log rank statistic was used to test for ethnic differences in time to institutionalization. Cox regression analyses were conducted to determine whether care-recipient or caregiver characteristics (e.g., care-recipient age and memory and behavior problems; caregiver depression, years of education, income, and views of the caregiving role) significantly interacted with ethnicity to explain time to institutionalization.Latinas delayed institutionalization significantly longer than their Caucasian counterparts; care-recipient characteristics or caregiver demographics did not explain these results, although Latinas who identified greater benefits or more-positive aspects of the caregiving process at baseline were less likely to institutionalize their loved one than those who reported fewer benefits of caregiving. Less-acculturated Latinas were significantly more likely to identify positive aspects of caregiving than more-acculturated Latinas.Latina dementia caregivers delay institutionalization significantly longer than female Caucasian caregivers. In addition, Latino cultural values and positive views of the caregiving role are important factors that may significantly influence their decision to institutionalize loved ones with dementia.

Abstract

Few empirical studies have compared the efficacy between psychoeducational (skill-building) approaches for reducing caregivers' psychological distress and interventions modeled after typical community-based support groups. We compare the impact of two distinct interventions on Anglo and Latino caregivers of elderly relatives with dementia.The change from preassessment to postassessment (baseline to 3 months) for 213 female caregivers (122 Anglo and 91 Latino) is presented. They were seen weekly for 10 weeks in either the Coping With Caregiving psychoeducational program (instruction and practice in small groups to learn specific cognitive and behavioral skills) or in the Enhanced Support Group condition (guided discussion and empathic listening to develop reciprocal support within the group). Both programs were tailored to be sensitive to the cultural concerns of Anglo and Latino caregivers, and they were delivered in either English or Spanish by trained interventionists.Overall, participants in the Coping With Caregiving condition reported a significant reduction in depressive symptoms, increased use of adaptive coping strategies, and a trend toward decreased use of negative coping strategies when compared with those in the Enhanced Support Group condition. Results were similar for both ethnic groups: there were no main effects for ethnicity, and no significant ethnicity by treatment interaction effects.This study provides empirical support that female caregivers benefit more from a skill-building approach to managing their distress than from support group membership alone. We find it very encouraging that the Latino caregivers responded well on key outcome variables, suggesting that Latinos will participate in clinical research and will benefit from their involvement when services are provided to meet their specific needs.

Abstract

The authors extend previous research on homework in psychotherapy by examining the relationship between homework compliance and therapeutic outcome among depressed older adult outpatients (N = 63), addressing previous limitations by using session-by-session therapist ratings of homework compliance and including both interviewer ratings and patient self-reports of outcomes.Patients were participants in a randomized clinical trial evaluating the efficacy of desipramine versus cognitive/behavioral therapy-alone (C/B-Alone) versus a combination of the two (Combined). Given the current study's focus on homework compliance, only patients assigned to conditions with assigned homework in the clinical trial (i.e., C/B-Alone and Combined conditions) were included.Results of hierarchical regression analyses indicated that homework compliance contributed significantly to posttreatment outcome as measured by both interviewer-administered and patient self-report measures of depression. A separate series of ANOVAs also found significant differences in pre-posttreatment change between patients scoring above and below the median of reported homework compliance. Findings were similar for patients in the C/B-Alone and Combined conditions.The study's results call for additional research on issues related to homework compliance with older adult patients.

Abstract

The authors evaluated the efficacy of desipramine-alone, vs. cognitive/behavioral therapy-alone (CBT) vs. a combination of the two, for the treatment of depression in older adult outpatients. Patients (N=102) meeting criteria for major depressive disorder were randomly assigned to one of these three treatments for 16 to 20 therapy sessions. All treatments resulted in substantial improvement. In general, the CBT-Alone and Combined groups had similar levels of improvement. In most analyses, the Combined group showed greater improvement than the Desipramine-Alone group, whereas the CBT-Alone group showed only marginally better improvement. The combined therapies were most effective in patients who were more severely depressed, particularly when desipramine was at or above recommended stable dosage levels. The results indicate that psychotherapy can be an effective treatment for older adult outpatients with moderate levels of depression.

A comparison of marital interaction patterns between couples in which the husband does or does not have Alzheimer's diseaseJOURNALS OF GERONTOLOGY SERIES B-PSYCHOLOGICAL SCIENCES AND SOCIAL SCIENCESGallagher-Thompson, D., Dal Canto, P. G., Jacob, T., Thompson, L. W.2001; 56 (3): S140-S150

Abstract

Objectives. Our main purpose was to examine similarities and differences in patterns of interpersonal interaction between Alzheimer's disease (AD) caregiving and noncaregiving couples (n = 54). Methods. Twenty-seven wives caring for moderately impaired husbands with probable AD and 27 noncaregiving wives from comparable sociodemographic backgrounds were videotaped in their homes during both mealtime and a future event planning task. In addition, they completed self-report questionnaires to assess depression, stress, relationship mutuality, and perceived hope. Results. Compared with their counterparts, caregiving wives reported higher levels of depression and stress, but similar shared values and closeness. For the three factors developed from the Marital Interaction Coding System (MICS, version IV; Supportive Facilitative, and Rapport Building), a complex pattern of results was found in which disease status, type of task, and gender interacted significantly. Noncaregiving couples were more interactive overall and expressed more support to each other. Caregiving wives were found to be most facilitative during the planning task, whereas AD husbands were highest on interactions that built rapport (e.g., smiling) during that same task. Caregiving wives actually increased their facilitative behavior from the mealtime to planning task, probably reflecting the increased demand characteristics of the latter.This study is one of a small body of literature to describe the negative impact of AD on spousal communication as observed and coded in two videotaped interaction situations in the home. Suggestions are made for future research, including the inclusion of longitudinal designs and non-Caucasian couples.

Abstract

alpha2 Macroglobulin is a panproteinase inhibitor that is found immunohistochemically in neuritic plaques, a requisite neuropathologic feature of AD. Recently, a pentanucleotide deletion near the 5' end of the "bait region" of the alpha2 macroglobulin (A2M) gene was reported to be associated with AD in a large cohort of sibpairs, in which the mutation conferred a similar odds ratio with AD as the APOE-epsilon4 allele for carriers of at least one copy of the A2M gene (Mantel-Haenszel odds ratio, 3.56).We studied three independent association samples of AD patients (n = 309) with an age range of 50 to 94 years and representative controls (n = 281) to characterize the allele frequency of the pentanucleotide deletion in this cohort. We detected the mutation near the 5' splice site of exon 18 using standard PCR and restriction fragment length polymorphism methods. The results were adjusted for age, gender, education, and APOE polymorphism.We found that the A2M gene polymorphism conferred an increased risk for AD, with an estimated Mantel-Haenszel ratio of 1.5 (95% CI 1.1 to 2.2; p = 0.025). There was no age- or gender-dependent increase in A2M gene allele frequencies in AD patients compared with controls. The combined sample showed the expected association between AD and APOE-epsilon 4. In one of our three samples there was an interaction between the A2M and APOE-epsilon4 genes, but the other two samples showed no interaction between the two risk factors.Our data support an association between the A2M gene and AD. This association is less pronounced, however, in our cohort than in the previously reported sample of sibpairs.

Abstract

This study investigated the relationship between hormone replacement therapy (HRT) use and physical and psychosocial functioning in a sample of chronically stressed older women.Participants (N = 94) were postmenopausal women caring for a parent or spouse with dementia. Caregivers were evaluated using both psychological and physical health indices.Caregivers receiving HRT reported lower levels of hostility and were less likely to report unpleasant interactions with members of their support network; these findings were unrelated to demographic variables, caregiving-related indices, or health behaviors. HRT recipients had lower 10-year risk scores for cardiovascular disease, but there were no group differences in stroke risk. The largest effects on hostility, depression, heart and stroke risk were observed in caregivers receiving a combination of estradiol and progesterone.HRT for postmenopausal women may promote positive outcomes for some, but not for all, affective states and cardiovascular variables vulnerable to chronic life stressors.

Abstract

The alpha 1-antichymotrypsin (ACT) A allele was recently associated with Alzheimer's disease (AD), and the ACT AA genotype was reported to be more frequent in AD subjects with the apolipoprotein E (APOE) epsilon4 allele. We examined ACT and APOE genotypes in a sample of 160 subjects with probable AD and in 102 elderly control subjects. ACT A allele frequencies were similar in AD subjects (0.503) and elderly controls (0.519). In addition, we found no evidence that in AD the AA genotype is more frequent in subjects with the APOE epsilon4 allele than in those without it. Our results do not support an association between the ACT A allele and AD.

Abstract

A music-facilitated psychoeducational strategy was developed as a cost-effective and accessible intervention for older adults experiencing symptoms of depression, distress, and anxiety. Thirty older adults who had been diagnosed with major or minor depressive disorder were randomly assigned to one of three 8-week conditions: (1) a home-based program where participants learned music listening stress reduction techniques at weekly home visits by a music therapist; (2) a self-administered program where participants applied these same techniques with moderate therapist intervention (a weekly telephone call); or (3) a wait list control. Participants in both music conditions performed significantly better than the controls on standardized tests of depression, distress, self-esteem, and mood. These improvements were clinically significant and maintained over a 9-month follow-up period. The potential for this type of intervention with homebound elders and others who have limited access to services is discussed.

Abstract

To determine whether cognitive function improves with improved glycemic control in older subjects with non-insulin-dependent diabetes (NIDDM). We hypothesized that with improved glycemic control: 1) learning and memory, 2) attention, and 3) complex perceptual-motor function would improve, but that 4) simple perceptual-motor function would not.Non-randomized control trial.Aging Study Unit, Department of Veterans Affairs Medical Center.Thirty subjects with NIDDM; 17 on oral hypoglycemic agents; 13 untreated at study entry. Thirteen normal controls.Subjects on oral hypoglycemic agents were taken off medications. After 1 month, they and previously untreated subjects began treatment with glipizide. Dose was titrated up weekly until fasting plasma glucose was less than 7.8 mmol/L or maximal dose (40 mg/day). Controls received no medication.Fasting plasma glucose (FPG), glycated hemoglobin, and measures of cognitive function in four general categories: 1) learning and memory, 2) ability to sustain attention, 3) complex perceptual-motor function, and 4) simple perceptual-motor function. All were evaluated in subjects with NIDDM at baseline (T1), after 1-month washout (T2), and after 2 (T3) and 4 months (T4) of optimal glycemic control or maximal dose. Controls were evaluated at the same intervals.FPG and glycated hemoglobin rose in previously treated subjects from T1 to T2 (9.4 +/- SEM 0.4 to 14.7 +/- 0.7 mmol/L and 10.9 +/- 0.7% to 12.2 +/- 0.6%, respectively) but were unchanged in previously untreated subjects (11.3 +/- 0.6 to 11.8 +/- 0.9 mmol/L and 10.9 +/- 0.7% to 11.7 +/- 0.7%). With glipizide treatment, there was a decrease in FPG level at T3 (9.4 +/- 0.5 mmol/L in previously treated, 6.9 +/- 0.4 mmol/L in previously untreated), which persisted at T4. Glycated hemoglobin fell similarly. FPG and glycated hemoglobin were unchanged in controls. As hypothesized, learning and memory improved over time with treatment in both groups of subjects but was unchanged in controls (P < 0.05). Detailed analysis indicated that the improvement occurred primarily in the learning of verbal material. Contrary to hypothesis, attention and complex perceptual-motor function did not show improvement. As expected, simple perceptual-motor function did not show any improvement with treatment.The results are consistent with previous findings that poor glycemic control in older subjects with NIDDM is associated with decreased cognitive functioning, and suggest that verbal learning and memory may improve with improved glycemic control.

Abstract

To compare the effects of atenolol and nifedipine on mood and cognitive function in elderly hypertensive patients.Randomized, double-blind, crossover trial.Thirty-one elderly volunteers (7 women and 4 men) 60 to 81 years of age with mild to moderate hypertension were recruited from the general community and a Veterans Affairs hospital hypertension clinic. Six volunteers withdrew at early phases of the study for reasons unrelated to adverse drug effects.Participants had 2 weeks of placebo, to 6 weeks of titration with atenolol or nifedipine, and weeks of treatment followed by similar periods with the other drug.Psychometric tests designed to assess mood and cognitive function.In the group first treated with nifedipine, the summed recall score on the Buschke selective reminding test (a test of verbal learning and memory) decreased by 9.3 words (95% CI, 2.8 to 15.6 words), or 0%, during nifedipine treatment compared with placebo (P = 0.031). The group first treated with atenolol showed no improvement in summed recall scores when results seen during atenolol therapy and placebo administration were compared (P = 0.10); however, this group had an improvement of 16.1 words (CI, 5.6 to 26.5 words), or of 16%, when the atenolol score was compared with the nifedipine score (P = 0.026). In the group first treated with nifedipine, 6 of 11 patients 55%) showed a decrease of 5 words or more during nifedipine therapy compared with placebo, whereas only 1 of the 14 patients (7%) in the group first treated with atenolol showed a similar decrease (P less than 0.01). On the digit symbol test (a psychomotor test), patients treated first with atenolol tended to improve, whereas patients treated first with nifedipine tended to decline. The difference between nifedipine and atenolol, in terms of the change from the score seen during placebo, was 4.3 codings (CI, 0.7 to 7.9 codings) or 10% (P = 0.043). No statistically significant differences were seen between nifedipine and atenolol therapy regarding the other measures of psychomotor ability, sustained attention, motor performance, verbal fluency, or abstract reasoning, and no effects of either drug on mood or psychopathologic symptoms were noted.Although atenolol and nifedipine are generally free of gross effects on cognition or mood, nifedipine may subtly impair learning and memory in some elderly hypertensive patients.

Abstract

This article describes agreement among diagnoses made according to five definitions of endogenous depression in a sample of 99 depressed elders and discusses the relationship among these systems and selected demographic and clinical characteristics. Poor to fair agreement was generally demonstrated, except for Research Diagnostic Criteria (Spitzer, Endicott, & Robins, 1978) and Diagnostic and Statistical Manual of Mental Disorders, 3rd ed., rev. (American Psychiatric Association, 1987), which demonstrated excellent agreement. Mostly, demographic and clinical variables (e.g., severity of depression) were unrelated to endogeneity diagnoses. The conclusion was reached that these criteria are not all measuring the same construct in older adults and that the relationship between depression severity and endogeneity should be discussed in terms of specific definitions rather than general terms.

Abstract

Self-report measures of grief, depression, and general psychopathology were studied in widows and widowers over a 2.5-year period following death of their partner. A comparison sample of men and women was also followed for the same period. Differences in severity of depression and psychopathology previously reported at 2 months postloss (Gallagher, Breckenridge, Thompson, & Peterson, 1983) diminished to nonsignificant levels at 12 and 30 months. However, significant differences between bereaved and comparison subjects on measures of grief were still apparent 30 months after spousal loss. A main effect of gender for depression and psychopathology (but not for grief) was found at 2 and 12 months: Women reported more distress than men regardless of bereavement status. Results indicate that the experience of grief persists for at least 30 months in both older men and women who have lost their spouse.

Abstract

Three hundred ninety-three elderly adults aged 55 and older were divided into 1 of 9 subgroups in a 3 (bereavement group: survivors of spouses who died by natural death or by suicide and nonbereaved control Ss) x 3 (depression group: none, mild, and moderate-severe) design over 4 times of measurement--1 month, 6 months, 1 year, and 2.5 years after death of spouse. Significant Bereavement x Depression Group effects were obtained on Brief Symptom Inventory scores. The moderate-severe depression/suicide subgroup had the greatest psychiatric complications with bereavement. Results indicated that elderly persons with significant clinical depression at the time of a spouse's death were at significant risk for psychological complications during the bereavement process, and survivors of spouses who had committed suicide were even more at risk within the greatest depression group.

Abstract

Cross-sectional and longitudinal data are presented from a 2-year follow-up study of 91 older adults, initially diagnosed as in an episode of major depressive disorder (MDD), who were treated with brief cognitive, behavioral, or psychodynamic psychotherapy. Using research diagnostic criteria (RDC), 52%, 58%, and 70% of the sample did not meet criteria for any RDC depressive disorder at posttherapy, and 12- and 24-month follow-ups, respectively. There were no significant differences in response rate by therapy modality. Using Longitudinal Interval Follow-up Evaluation (LIFE; Shapiro & Keller, 1979; Keller et al., 1987) methodology, we noted that patients not depressed at posttreatment remained depression-free for longer time periods than those who were minor or MDD. These rates compare favorably with published reports on younger depressed patients.

Abstract

Two hundred twelve bereaved elders rated marital adjustment using items drawn from the Locke and Wallace (1959) Marital Adjustment Test and completed the Beck Depression Inventory 2 months, 12 months, and 30 months after the loss of their spouses. Their responses were compared with those of 162 nonbereaved individuals of comparable age who were tested at the same times. More positive ratings of marital adjustment were made by bereaved subjects than by nonbereaved subjects. Among nonbereaved elders, more severe ratings of depression were associated with lower ratings of marital adjustment. In the bereaved sample, however, the opposite was found: More severe ratings of depression were associated with higher ratings of marital adjustment. This pattern of results changed only slightly over the 2.5-year course of bereavement and was not influenced by gender. These results are discussed in terms of cognitive processes (e.g., idealization) that influence retrospective assessments of marital adjustment during bereavement.

Abstract

Data were collected shedding light on the brain electrical activity underlying word recognition. Subjects listened to a list of 48 spoken words in six random orders under two instructional sets: first to "think about the meanings of the words," and second, to learn the list. The scalp EEG associated with hearing and identifying the words was recorded at F3, F4, Cz, P3, P4, Pz, and Oz. Standard within-subjects time-locked averaging across words showed a late negative-positive complex with N2-P3 topography, the negative component peaking around 480 msec, the positive component peaking around 830 msec. Averaging within words across subjects uncovered considerable latency variability in both components. Within-word N2 and P3 component latencies covaried with word durations and with the "recognition points" predicted for the words by the "cohort theory" of word recognition. N2 latencies corresponded closely to the "N400" effect elicited with semantically incongruous sentence-final spoken words. Implications for ERP investigations of language processing are discussed.

Abstract

The nature and extent of cognitive impairment was examined in 29 healthy elderly subjects (mean age 69.8 yr) with non-insulin-dependent diabetes mellitus (NIDDM) and 30 demographically similar nondiabetic community volunteers (mean age 68 yr). Measures of verbal learning, abstract reasoning, and complex psychomotor functioning were performed more poorly by diabetic than nondiabetic subjects. Conversely, there were no between-group differences in performance on tasks involving pure motor speed and simple verbal abilities. Within the diabetic group, individuals with poorer metabolic control performed more poorly on tasks involving learning, reasoning, and complex psychomotor performance, although this relationship was not evident for simple verbal or motor tasks. These data indicate that older people with NIDDM who are functioning well and perceive themselves as in good health are likely to manifest greater deficits than healthy elderly people in processing complex verbal or nonverbal material. Possible explanatory mechanisms are discussed, and directions for future research are explored.

Abstract

Family caregivers who sought help to increase their coping skills (N = 158) and caregivers who volunteered for a longitudinal study of Alzheimer's disease (N = 58) were screened for depression. Among help-seekers, 46% had depression according to Research Diagnostic Criteria (RDC), but among non-help-seekers, only 18% met this criterion. In general, women were more depressed than men, but no major differences in the extent of depression were found in those who cared for more impaired persons.

Abstract

Older adults who met criteria for major depressive disorder were randomly assigned to behavioral, cognitive, or brief dynamic therapy. Symptoms were equally reduced across the three treatment conditions. Early in treatment, alliance ratings were obtained from both therapists and patients and were related to outcome. We calculated one therapist alliance composite score and five patient alliance factor scores. In general, no agreement was found between therapists' and patients' judgments of alliance. Levels of alliance were found to be not significantly different across the three treatment conditions. For the sample as a whole, only the patient factor of Patient Commitment was found to be associated with depressive symptoms after treatment, with the strongest findings in the cognitive therapy condition. The Patient Commitment factor uniquely contributed to outcome over and above the contribution of initial symptomatology and symptomatic change at midpoint in therapy. Expected trends of association with outcome were observed for the therapist alliance composite score in brief dynamic therapy and for the patient factor of Patient Working Capacity in both cognitive and brief dynamic therapy. Findings are discussed in terms of their theoretical and clinical implications.

Abstract

Suicidal ideation in the elderly has been related to depression, changes in health, and anticipation of a limited future. The present study examined the Hopelessness Scale (HS) and its relation to these factors in a depressed geriatric population. A total of 120 elderly outpatients, who had applied to receive psychotherapy for depression, completed the HS, Beck Depression Inventory (BDI), health ratings, and the Schedule for Affective Disorder and Schizophrenia (SADS) at intake. The HS was found to be internally consistent, and a principal components analysis revealed three distinct factors that were related to hope, feelings of giving up, and future planning. The HS, BDI, and health ratings were predictive of suicidal ideation as measured by specific items in the SADS. The relation among suicidal ideation hopelessness, depression, and health perceptions for the depressed aged are discussed.

Abstract

Profiles of 21 self-reported depression symptoms from 196 recently bereaved elders (mean age = 67.70 years) were compared with those of 145 comparison control participants (mean age = 70.01). Responses from bereaved individuals were recorded approximately 2 months following the loss of their spouse. Comparison participants were married or, if single, had not lost a spouse to death or divorce in the previous 5 years. Results were consistent with the literature concerning normative bereavement reactions; that is, although bereaved people reported several features associated with depression, the likelihood of self-deprecatory cognitions was no greater among them than among control participants. Bereaved individuals were significantly more likely to report heightened dysphoria, dissatisfaction, and somatic disturbances typical of depression, even when variations in age, sex, number of years married, and educational and occupational status were taken into account. Differentiation of bereaved/control participants on some dysphoric features was dependent on the number of years married.

Abstract

Multiple indices of self-perceived physical health for 212 older widows and widowers, 2 months following the loss of their spouse, were contrasted with the responses of 162 comparison control participants for a comparable period. Although physician visits and hospitalizations were reported to be no more frequent among the bereaved, they did report significantly more recently developed or worsened illnesses, greater use of medications, and poorer health ratings in general. These differences were independent of sex and variation in socioeconomic background. Significant sex differences, although minimal, indicated poorer perceived health among women.

Abstract

The effects of bereavement on self-report measures of psychological distress were evaluated in widows and widowers at approximately 2 months after the death of a spouse. These data represent the first time of measurement in an ongoing longitudinal study of conjugal bereavement in elders. Responses of 95 male and 104 female elderly bereaved on measures of grief, depression, global severity of psychological distress, and general mental health functioning were compared with those of 79 male and female elderly individuals who were not currently suffering from the loss of a spouse. In general, means for the bereaved group were not in ranges consistent with the presence of serious psychopathology. Women in both groups reported greater distress than men, and significant sex-by-bereavement-status interactions on mental health measures were not observed.

Abstract

This study explored the effectiveness of brief psychotherapies for treatment of elderly depressed outpatients. All were in a current episode of major depressive disorder, but half the sample (n = 15) presented with endogenous symptomatology as well. Patients were assigned to either behavioral, cognitive, or insight-oriented psychotherapy for 16 sessions over a 12-week period. Evaluation occurred before and after therapy, and at four times during a 1-year follow-up interval. Nonendogenous patients responded more favorably to psychotherapy; this differential effect persisted throughout follow-up. Significant improvement, however, was made by some endogenous patients. One-third were not depressed by termination of therapy, and seven others were notably improved. Eight of 15 had not relapsed at 1-year follow-up.

Abstract

The present study investigated the influence of depression on memory complaints and performance in a sample of community dwelling older adults (N = 41). Complaints were significantly more frequent in the clinically depressed subsample. However, their actual performance on tests of immediate and delayed recall did not differ significantly from the performance of nondepressed older adults. In addition, results indicated that depressives who responded favorably to a program of psychotherapy demonstrated significant reductions in levels of memory complaints at post-treatment assessment. Implications of these data for further research are discussed.

Abstract

An emitted potential paradigm was used to investigate P3 scalp potentials in a group of older individuals (M = 66.8 years) and a group of younger persons (M = 22.0 years). Since no physical stimulus is necessary to elicit an emitted potential, an age comparison of P3 can be made which does not depend on normal sensory transmission channels. Both traditional and latency corrected averages to missing auditory clicks were analyzed from electrodes placed over midline frontal, central, and parietal locations. Results indicated that while the scalp distribution of emitted potentials was similar for both age groups, amplitudes at Pz and Cz were significantly smaller in the older group. Latency corrected potentials indicated similar trends but did not reach significant levels. No group differences were seen for N2 or P3 latencies for either traditional or corrected averages. The findings support age differences in the amplitudes of the P3 component and suggest that when P3 is not synchronized with a sensory event, latencies in this component may not be sensitive to age differences.

Abstract

A spouse's death requires more readjustment on the part of the bereaved than any other stressful life event. This finding holds across the many age groups and cultural backgrounds that have been studied. Although it is unclear as to whether the stress of bereavement is greater for women than for men, for the young than for the old, for one socioeconomic level or for another, a critical review of the literatures suggests the following: 1) Negative changes in physical health, mortality rate and mental health status usually accompany widowhood; 2) Complex social-psychological variables such as the individual's characteristic ways of coping with stress (coping strength), the adequacy of the social network - plus other factors such as income and religious commitment - may attenuate widowhood's negative impact. Suggestions for further research include studies exploring differential adaptation to widowhood across age groups and in elderly men and women, and longitudinal studies tracing the process of recovery from acute grief.

Abstract

Age and sex differences in the brainstem auditory evoked response (BAER) were investigated in older (60 to 79 yrs), middle-aged (40 to 59 years), and young (20 to 39 yrs) individuals. Within each age group the number of males (N = 10) and females (N = 10) were divided equally. Scalp potentials were recorded from the vertex to clicks presented at 60, 70, and 80 dB(SL) for stimulus rates of 5, 10, and 15 clicks/sec. Results indicated that older adults had longer latencies at Wave III than either middle-aged or young adults. Age effects were also found for Waves I, II, and IV but were restricted to the lowest intensity and were more evident in older males than females. Significant sex effects showed that the females in each group had shorter Wave IV and V latencies than males. The results suggest that age affects neural propagation at the level of the olivary complex (Wave III) and that BAER latencies are also influenced by the sex of the individual.

Abstract

The effects of distraction on the contingent negative variation (CNV) were investigated in a group of 11 elderly (mean = 72.2 years) and a group of 12 young (mean = 23.3 years) subjects. Scalp electrical activity was recorded from midline sites at frontal, central, and parietal locations. Three experimental conditions included Recall, No Recall, and Control situations. In the Recall, or distraction condition, spoken consonant-vowel-consonant (CVC) letters were presented concurrently with the CNV signal interval and were recalled by the subjects after each trial. The No Recall condition was similar to the Recall task except that subjects were not required to repeat the CVSs. The Control condition presented a standard S1 - S2 CNV situation without CVCs. Amplitudes of the CNV, reaction times (RTs), and heart rate (HR) served as indices of distraction. The effects of distraction for both age groups indicated reduced CNVs, lengthened RTs, and elevated HRs. However, a significant age by electrode interaction revealed that while CNV amplitudes at central and parietal sites were comparable between age groups, amplitudes at the frontal placement were consistently reduced in the elderly compared to the young in all conditions. The finding of diminished frontal activity, as measured by the CNV, suggests a process of selective cortical aging and possible cellular loss which may be linked to performance deficits.

Abstract

The averaged evoked potential to brief tones was compared for 10 young and 10 elderly female subjects. The amplitudes of the sensory components (P1, N1 and P2) were not affected by an infrequent change in pitch of the tones or instructing subjects to count or ignore them; but overall the elderly had a larger P1 and smaller P2 amplitude and a difference in the scalp distribution of P2. Repetition of the tones produced a decrement in these sensory components and a differential one for young and old subjects A slow potential complex consisting of components N2, P3 and SW appeared to changes in tone pitch and became more pronounced when attention was directed to the tones. Overall smaller SPs for oder subjects were interpreted as evidence for a change with age in the cortical representation of the orienting response. Topographical analysis of SPs indicated diminished activity in frontal (Fz) electrodes for elderly persons, suggestive of an enhanced aging process in the frontal cortices.

Abstract

Sex differences in the amplitudes and latencies of the auditory brain stem potential (BAEP) were investigated using 3 levels of intensity and 3 stimulus presentation rates. The females displayed consistently larger BAEPs for waves IV, V, VI, VII than the males. The only latency differences which reached significance over all the intensities and rates occurred for wave V. The females showed significantly shorter wave V latencies than the males. Since hearing losses and individually determined click thresholds were comparable between the two groups tested, the exact sources of the uneven distribution of amplitude and latency effects are in question. Differences in the relative distances of the anatomical generators are considered in accounting for the sex differences. Because the precise origin of the sex differences cannot be stated with certainty at this time, attempts to develop normative data for the BAEP should consider the possible influences of sex differences.

Abstract

Age differences in visual sensory memory were studied using the direct measure procedure of Haber and Standing (1969) -- the longest interstimulus interval at which subjects reported a single stimulus as continuous was measured. The visual storage of the young (mean age 24 years) was found to persist for 289 msec compared to 248 for the old (mean age 67 years). Similar estimates of sensory memory duration were obtained when either monoptic or dichoptic stimulus presentations were employed, supporting the idea that visual storage is centrally mediated for both age groups. The relevance of these findings for age differences in the registration of information into primary and secondary memory and their implications for the stimulus persistence hypothesis are considered. The appropriateness and validity of the persistence of form task for studies of sensory memory and aging are also discussed.

Abstract

The present investigation was designed to examine the effects of orienting task-controlled processing on electrodermal response and free recall at two delay intervals for 94 young, 49 young-old (age 55 to 70), and 61 old-old (age 71 to 85) individuals. Subjects were presented with a list of 25 words and performed one of the following tasks: semantic, nonsemantic, or passive listening, presented in an incidental memory paradigm, or intentional memorization. Recall was obtained 2 min or 48 hours after list presentation. At the 2-min delay, the pattern of recall across tasks for the young-old and old-old subjects was similar to that of college students. Overall, the old-old recalled fewer words than the young and young-old, while the young-old recalled as many words as the young. After 48 hours, the task-related recall pattern was observed only in the young group. The skin conductance data indicated that task effects were similar across the three age groups and that response magnitude was lower in the old-old than the two younger groups. No differences in skin conductance were found between the young and young-old. Age differences in memory processing suggest that difficulties in delayed retrieval of semantically encoded words may increase during late adult years. Differences in electrodermal responses in the old-old compared to the young and young-old suggest that the range of autonomic responsivitiy to task demands may become restricted in advanced age.

Abstract

The relationship between heart rate deceleration (HRD) and the contingent negative variation (CNV) was evaluated in 12 healthy, elderly men during performance of a signaled reaction time task. While amplitude of the CNV and HRD did parallel RT, CNV alone was found to be predictive of individual differences in speed of response indicating that phasic concordance of these physiological responses is probably not an important factor in age changes in RT. The results indicate the probable importance of central physiological indices such as the CNV over peripheral events such as HRD in the evaluation of RT performance in elderly individuals.

Abstract

This study tested the effects of repeated exposures to hyperbaric oxygen (HBO) on psychological, electroencephalographic, and cerebral blood flow measures in 8 patients with cerebrovascular disease and 13 patients with cortical atrophy. Patients were exposed to 100% oxygen at 2.5 atmospheres absolute twice daily for 90 min. for 15 days. No significant changes were observed in any of the measures in either group. Level of initial functioning was not associated with change due to treatment. Results suggest that HBO has no therapeutic effect in patients with moderate to severe dementia.

Conference Proceedings

Abstract

Cognitive-behavioral therapy is a brief psychotherapy stemming from a model that emphasizes the importance of distorted thoughts and the lack of pleasurable activities in the development of affective disorders. The focus of the therapy can be on either eliminating distorted thought systems or increasing the number of pleasant events that occur on a daily basis, or both. The highly structured therapy presents various skills for patients to learn through class exercises and homework assignments. Older adults respond well to cognitive-behavioral therapy, reporting that they appreciate the structure and the opportunity to learn skills that can help when they are confronted with new stresses. Many also like the focus on here-and-now problems rather than the past. A few treatment modifications are necessary to accommodate community elders complaining of depression. Generally, information must be presented more slowly, taking advantage of multiple modes of presentation. To maintain an active learning process, elder patients should be asked frequently to summarize the material being presented. They should also be given handouts of complex materials and encouraged to maintain notebooks. Other modifications may be required for special populations of older patients.